Subjective Criteria Make Bipolar Diagnosis Tricky. (Bipolar Disorder in Children)

By Boschert, Sherry | Clinical Psychiatry News, February 2002 | Go to article overview

Subjective Criteria Make Bipolar Diagnosis Tricky. (Bipolar Disorder in Children)


Boschert, Sherry, Clinical Psychiatry News


HONOLULU -- Diagnosticians could be divided into "lumpers" and "splitters" when it comes to diagnosing bipolar disorder in children, according to findings presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry

"Splitters" follow DSM-IV criteria requiring an episodic course of illness--a distinct change in mood lasting at least 1 week for mania or 4 days for hypomania. Many other physicians--the "lumpers"-- give a diagnosis of bipolar disorder to children without episodic illness who instead present with chronic irritability or mood lability.

The more conservative diagnostic criteria identify a distinct population of children with uniquely manic symptoms, increased psychosis, and more suicide attempts, compared with children diagnosed using the loose criteria.

While recruiting patients to a study of bipolar disorder in children using the stricter DSM-IV criteria, investigators compared data on 21 children accepted into the study with data on 37 children being treated for a diagnosis of bipolar disorder who were excluded from the study because they had a history of episodic illness. Data were collected in 2- to 6-hour phone interviews and from reviews of medical records.

The "narrow phenotype bipolar" group showed significantly higher rates of all manic symptoms except irritability, including elation, grandiosity, decreased need for sleep, goal-directed activity pressured speech, racing thoughts, and pleasure seeking, Dr. …

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